We do not smoke but some of us are more susceptible than others: A multilevel analysis of a sample of Canadian youth in grades 9 to 12

• Smoking susceptibility significantly varied across Canadian secondary schools.
• Smoking susceptibility was associated with having low self-esteem or using alcohol.
• Other factors included marijuana use or holding positive attitudes towards smoking.
• Others were having smoking friends or residing in homes with no smoking bans.
• Tobacco retailer density was not associated with smoking susceptibility.

BackgroundSmoking susceptibility has been found to be a strong predictor of experimental smoking. This paper examined which student- and school-level factors differentiated susceptible never smokers from non-susceptible never smokers among a nationally representative sample of Canadian students in grades 9 to 12.MethodsStudent-level data from the 2008–2009 Canadian Youth Smoking Survey were linked with school-level data from the 2006 Census, and one built environment characteristic (the density of tobacco retailers surrounding schools). These data were examined using multilevel logistic regression analyses.ResultsThe likelihood of a never smoker being susceptible to smoking significantly varied across schools (p = 0.0002). Students in this study were more likely to be susceptible never smokers if they reported low self-esteem, held positive attitudes towards smoking, used alcohol or marijuana, had close friends who smoked, and came from homes without a total ban on smoking. The school location (rural versus urban), the socioeconomic status of the neighbourhood surrounding a school, and the density of tobacco retailers that were located within 1-km radius of each school were not associated with students' smoking susceptibility.ConclusionThese findings underscore the continued need to develop school-based tobacco use prevention policies and/or programs that enhance students' self-esteem, address tobacco use misinformation and substance use, and include strategies targeting friends who smoke, and students who come from homes without a total ban on smoking.